APPLICANT'S ABSTRACT: Expansion of managed care technologies for publicly-funded alcohol treatment services is likely to stimulate change in the organization and delivery of treatment. Managed care imposes cost-controls, standardization, and accountability on providers in order to balance utilization of services with cost containment while maintaining quality of care. In response to controls and incentives, treatment agencies may modify corporate structures (merge, close, and develop networks), increase standardization of clinical processes (e.g., admission/discharge criteria), alter staffing patterns (use of experiential counselors), and invest in automated information systems. All licensed outpatient substance abuse treatment agencies (n = 412) in the six New England states will be surveyed and state initiatives on managed care will be monitored. The study design crosses six states (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and three points in time (month 6, month 24, and month 42 after project start). Analysis of six states over time provides multiple models of managed care, at different stages of development and helps to differentiate changes in the organization and delivery of services that may be unique to individual states, specific providers, and single moments in time. The investigation has four specific aims: Aim 1: Document managed care initiatives and purchase of service mechanisms for publicly-funded alcohol treatment programs in six New England states. Aim 2: Examine managed care influences on the organization of outpatient treatment programs including the development of provider networks, agency expansion and closure, the concentration of providers and provider specialization. Aim 3: Assess changes in the alcohol treatment workforce (counseling, medical, and administrative staffing) related to the introduction and expansion of managed care. Aim 4: Monitor change in service delivery and the use of clinical guidelines, standardized assessments, and automated information systems as related to the introduction and expansion of managed care procedures.